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-,. �� �P�'c: <br />circ nnnoES'i <br />3�j�9 ta�-a,on.� <br />LEGA LOT N0. <br />DESC. �l.l�(Lj� (,(� <br />PEkMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-25�J-8810 - FAX 425-257-8657 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />PARCEL TAX I.D. # o��4'HZI'�� � RMir � <br />a�� C� ��36q-gZ,.o��-°o � ����� -�y7 <br />�Z 1 P�m�T o�E �u�.iT fl�iJts�ou��q�� �3 (� (01 <br />ADDRESS CINIZiP PHO l��,-ts'{• ,'3 O <br />��M �A(�NhRs 1S13o- R �o,lamy �LdB Oe �Ll. CREkk WA 46oti <br />TENANTNAME CONTACTFORPERMIT PHONE <br />rJoN� M��� -�o�� �zS-�s�{-83 8 n <br />coNrancroa <br />°1re�Q. Q�wy�4 CAv>zu sa�L <br />CONTR. LICENSE # <br />4T�Q�c�qG�1 KH <br />USE OF BUILDING <br />2t-y,d,,E.n-�a� l.►U��:y ��Ty <br />ADDRESS <br />Q.Q.6oX 1b39 <br />Ooo,rracz P�rw-soa <br />HEATSOURCE <br />CITY2IP , PHONE <br />stiNo�wM.sl� y2s-�s�•83Qo <br />(y� �K� '�O� � <br />Eleclric _ _ _ Gas _ Olher <br />WORKDESCRIPTION -� "�"'-� �'�'��-�" <br />cous�a�cr ��) Two -i.��� 8���d"'`IS <br />5 cCk. WOtit� T�,L��H-� , La�a:ns�,��`..y <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Dathlub � <br />, Lavatory (wash basin) � <br />Shower f <br />_ itchen sink & disposal � <br />D iwasher 1 <br />Clot washer � <br />. Walrr h ter � <br />— Sink (servic ar/mop/cic. <br />— Backflow preve r <br />Urinai <br />Drinking Founlain <br />� Floor drain <br />Grease trap <br />Roof drains <br />_ Other <br />CONTRACT PRICE OF WORK <br />� 523� oo� <br />R�o R�.-Rr� <br />�� 1 Z�3 <br />t' I TYPE OF FI%TURE OR ITEM <br />_ VC — air handliny unils <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas ra <br />Cblhes d <br />Range hood I <br />Exhausifan <br />Hoat pump 1� <br />Unil healer <br />- Boiler <br />- Re(rigeration <br />� Woodstove <br />Olher <br />CIN OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceritify fhat I have read and examined this applicalion and know the same lo be true and correct. P.II provisions of laws and <br />ordinaces c�oveming this lype o( work will be complied wilh whelher speci(ied herein or not. The granling of a permit does not presume <br />to give authonly lo violalo or cancel the provision cf any other slate or local law regulating consWction or tho peAormance of <br />construction. That I am authorized by lho owner of thi, propr,rty to peAorm the �+�ork tor which app�ication is made and I comply with the <br />Slale Contraaors L�w48�27 RCVJ and 29G.200 WAC. . <br />�2zo6 <br />0 0 ' ��.� ,-, ,. Y <br />,�, a� <br />